A cluster randomized controlled trial (GOAL trial) evaluated a comprehensive geriatric assessment for frail older...

Frail older adults with chronic kidney disease (CKD) often experience complex care needs that may benefit from a comprehensive geriatric assessment (CGA). Our GOAL trial evaluated whether an outpatient CGA could improve patient-centered goal attainment in this population.

GOAL was an open-label, cluster-randomized controlled trial conducted across 15 Australian kidney outpatient centers from March 2021 to June 2023, with a 12-month follow-up. Centers randomized 1:1, delivered a single outpatient CGA plus usual care or usual care alone. Participants were aged 65 years and older (55 years and older for First Nations peoples) with moderate to severe CKD (eGFR 59 mL/min per 1.73 m² and under) and frail (Frailty Index over 0.25). Of 771 screened, 240 were enrolled (mean age 76.9 years; median Frailty Index 0.39; 56% male), and 179 (74.6%) completed follow-up. In intervention centers, geriatricians performed a one-off CGA and provided individualized management plans. The primary outcome was goal attainment at three months, assessed using Goal Attainment Scaling (GAS), where a mean score of 50 or more indicates goal achievement. Mixed-effects linear regression was used for analysis. Secondary outcomes included quality of life, frailty status, mortality, hospitalizations, and residential aged care admission. All analyses were intention-to-treat at both cluster and participant levels.

At three months, mean GAS scores were not significantly different between the intervention and control groups (45.2 vs 43.7; mean difference 1.54, 95% confidence interval: 3.13 to 6.20). No significant differences were found across secondary outcomes. A non-statistically significant reduction of 2.5 days in total hospital stay was observed in the intervention group.

Outpatient CGA did not improve goal attainment or clinical outcomes in frail older adults with CKD. These findings do not support routine implementation of single-episode outpatient CGA in this setting and suggest a need for alternative, integrated models of person-centered care.

Registered at ClinicalTrials.gov with study number NCT04538157.